It's estimated that fertility problems affect one in seven British heterosexual couples. That figure doesn't include gay and lesbian couples, or the individuals who pursue that route alone. Nor does it include the statistically invisible: the women and men who would love to have children but never find the right partner, or find them too late.

Some of these people will undertake fertility treatment. For many this will be a stressful and exhausting process that takes its toll on both the psyche and the bank account. The cycle of hope and despair can be heart-wrenching. Prospective parents may find themselves stranded on the fertility carousel for many years.

Mixed motives: The meanings of parenthood

So why do people consider it so important to have kids? The biological drive for parenthood has been much discussed. But sometimes other conscious or unconscious motivators may also be in play.

The couple whose relationship is struggling may imagine that a child will renew and consolidate a bond that is threatening to dissolve. Where unconditional love has ceased to exist between lovers the hope may be that it will be born again in a child.

For those who struggle to find meaning or purpose in their own lives, the role of caring for a baby may promise to fill that vacuum. Some may see parenthood almost as a rite of passage, a necessary initiation that will finally validate their adulthood. Or their gender identity. Or both.

By providing their own parents with grandchildren, some may hope to win their parents' approval, or to forge a separate family identity of their own. If their own childhood was difficult, they may idealise the perfect childhood that they hope to give their own baby, and imagine that this will heal the psychological hurt that they experienced themselves as vulnerable children.

Motherhood may also appear to be a tempting alternative to women who find themselves stuck in demanding or unrewarding employment which provides them with no sense of identity. Children can also be seen as a kind of insurance against the vulnerability of old age and loneliness.

Why is it important to consider these motivations? Because it may be unrealistic to imagine that a baby will magically resolve every conceivable anxiety or insecurity. And to place such a burden of expectation on a child would be no fairer than to make a lover completely responsible for one's happiness. There are some problems that we need to resolve for ourselves.

Those that still hope to have children might do well to consider that before they become parents. And those that are struggling with the idea that they might never become parents may also have to acknowledge that there are issues in their lives that might not have been resolved by having a child, and which will still need to be addressed.

Stuck: Childlessness and the need to grieve

To undertake fertility treatment is to gamble. It's possible to consider the odds, and to feel that one is making an informed decision, but the outcome can never be a certainty. And, just as gamblers can't bring themselves to walk away from the table, so couples are unwilling to abandon the process as the stakes rise with every round of treatment. Some will simply continue until all of their funds are exhausted.

The people that do abandon the process may feel that the failed treatment has left them so stunned and empty that they are completely unable to acknowledge what it is that they have experienced, or to understand what they feel about it. In these circumstances it can be very tempting to seek out displacement strategies to distract them from these troubling emotions. Workaholism, comfort eating, alcohol abuse or punishing and excessive exercise regimes: these are all means that people in this situation have deployed to avoid facing up to an overwhelming grief.

But loss will always need to be grieved. And the failure of fertility treatment is a profound loss. Without the expression of that grief it can be very difficult to move on at all. The single most important thing at this point can be to talk about feelings and to feel understood. The healing process requires us to tell our stories, to others and to ourselves, to consider the changed meaning of our lives, to begin to envisage a different future and to imagine how we might live in it.

It will be necessary to face grief, rather than to hide from it, and to understand its nature. Sometimes feelings will need to be confronted, and sometimes the most important thing will be to simply get on with life. This process is known as “oscillation” and is completely natural. This is how human beings adapt to loss.

The use of ritual shouldn't be underestimated as an aid to the grieving process. Sometimes individuals and couples who have experienced a failed fertility treatment or miscarriage create their own healing ritual such as planting a tree or plant, writing a letter, or reading a poem. Family and friends can be invited to take part in the ceremony. Ritual of this kind can answer a deep need for a painful loss to be acknowledged.

When fertility treatment comes to an end unsuccessfully, the participants have to abandon the idea of becoming the biological parents of a child. Other options exist, of course, and some people will feel able to move on and to consider them: egg donation, surrogacy, fostering, adoption. But others may make the decision to live without children.

A life without children can offer its own opportunities. Some of those that step off of the fertility carousel may discover in themselves a late flowering creativity in outlets such as art or writing. Some may take the chance to change their career, or to improve the quality of their life by reducing their working hours for example. The need to nurture others may be channelled into volunteering with children, or spending time with one's extended family.

The failure to become a parent can be traumatic but the life that continues after that trauma need not be without hope. Therapists are familiar with the phenomenon of “post traumatic growth” in which difficult experiences can be the spur for a new self awareness, and for the possibility of change. It's possible to reflect on and to appreciate the personal qualities that we have developed in the difficult times, and to begin an inner journey in which we explore and reassess our values, our relationships, the whole fabric of our life.

Reference

A creative approach to group work for women with fertility problems. Wheeler, Meredith. 1998.